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MSK II > Gluteal Region and Posterior Thigh > Flashcards

Gluteal Region and Posterior Thigh Flashcards

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28
Q

hip bone Large bone formed by the union of three bones:

A
  1. Ilium
  2. Ischium
  3. Pubis
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29
Q

illieum, pubis, and ischemia are separated by ____ in younger kids

A

tri radiate cartilage

30
Q

when the tri radiate cartilage fuses it forms the

A

acetabulum

31
Q

____ is the articular surface where the head of femur articulates in the acetabulum

A

Lunate surface

32
Q

Congenital Hip Dysplasia/Dislocation (CHD)

A
  • Girls have a greater incidence than boys
  • Physicians can utilize the position of the tri-radiate cartilage and the femur to determine the presence of CHD
  • Ossification center for the developing femoral head should be found with the lower inner quadrant
  • Acetabular index should be about 30º or less in a normal hip
  • Shenton’s line (S)…denoted by a continuous and symmetrical line between the obturator foramen and the medial aspect of the femur
33
Q

the hip joint is a ____ synovial joint consisting of the head of the femur and the acetabulum of the hip bone

and consists of a ____ strong and dense fibrous capsule that surrounds the joint

A

Ball-and-Socket; articular capsule

34
Q

Articular capsule is strengthened by three intrinsic ligaments which are ____ , ___ , and _____. Which one is the most important and why?

A
  1. Iliofemoral Ligament (or the Y ligament of Bigelow)- strongest and located on anterior aspect of joint- prevents hyperextension of the joint
  2. Pubofemoral Ligament- anterior/inferior aspect of the joint capsule (prevents hyperabduction)
  3. Ischiofemoral Ligament (ligament of Bertin)-a strong triangular ligament located posteriorly
35
Q

Fibers of all three ligaments are oriented in a ____ fashion around the hip so as to become tight in extension

A

“spiral”

36
Q

The rim of the acetabulum is surrounded by a strong fibrocartilagenous tissue called the ____ (helps protect and deepen the joint cavity)

A

acetabular labrum

37
Q

The labrum stretches across the inferior aspect of the lunate surface forming the ____

A

Transverse Acetabular Ligament

38
Q

___ attaches to the transverse acetabular ligament and to the femoral head at the fovea

A

Ligament of the Head

39
Q

____ (a branch of the obturator artery) courses within the ligament of the head of the femur and helps vascularize femoral head

A

Small “artery of the head”-

40
Q

Numerous arteries help vascularize the head of the femur:

A
  • Medial Circumflex Artery- from deep (profundal) femoral artery (major contributor…Step 1)
  • Lateral Circumflex Artery- from deep (profundal) femoral artery
  • Retinacular Arteries (aka…femoral neck vessels) – are the small actual branches from the medial and lateral circumflex arteries that perfuse the femoral head
  • Artery of the head- from the obturator artery that courses within the ligament of the head (considered a minor contribution)
41
Q

two types of femoral fractures and they are referred to has hip fractures

A

Femoral neck fractures

and

Intertrochanteric fractures

42
Q

____ often associated with osteoporosis…have a high incidence of avascular necrosis (AVN) of the femoral head due to rupture of retinacular arteries (femoral neck vessels)

A

Femoral neck fractures

43
Q

______ also common “hip fracture” in elderly patients, usually from a fall. More likely to use surgical repair than mechanical device/foriegn body replacement

A

Intertrochanteric fractures

44
Q

The two joints of the pelvic girdle include

A

sacroilliac joints (ventral and dorsal) and the pubic symphysis

45
Q

in addition to the sacralillio and pubic symphisis ligaments

A

two strong posterior ligaments the sacrospinous ligament and sacrotuberous ligament

46
Q

Structures of the Greater Sciatic Foramen (GSF):

A
  1. Piriformis muscle
  2. Sciatic nerve
  3. Superior & inferior gluteal nerves & vessels
  4. Posterior femoral cutaneous nerve
  5. Pudendal nerve & Internal pudendal artery exit the GSF
47
Q

Contents of the Lesser Sciatic Foramen

A
  1. After exiting the GSF…the Pudendal nerve & Internal pudendal artery then enter the LSF and travel to the perineum
  2. Obturator internus tendon
48
Q

gluteal maximus is innervated by the

A

nInnervated by the inferior gluteal nerve (L5,S1, S2)

49
Q

function of gluteus maximus

A

Functions mainly to extend and laterally rotate the thigh (hip)

50
Q

function of gluteus minimus and meatus

A

nThese two muscles are abductors of the hip (including the tensor fascia lata)

51
Q

innervation of gluteus minimus and meatus

A

nAll 3 abductors are innervated by the superior gluteal nerve (L4, L5 & S1)

52
Q

Trendelenburg Gait

A

secondary to weakness of the medius/minimus or damage to the superior gluteal nerve

“compensatory” gait… where an individual shifts their body weight over the weakened side to swing the contralateral limb through the gait cycle

53
Q

Trendelenburg test

A

when a patient is asked to stand on one leg to check the strength of these hip abductors…positive test is when the pelvis sags on the contralateral side which indicates weak hip abductors on the stance leg side

54
Q

Lateral Rotators of the Hip Joint

A
  1. Obturator Internus
  2. Superior Gemellus
  3. Inferior Gemellus
  4. Quadratus Femoris
  5. Piriformis
55
Q

Lateral Rotators
of the Hip innervation

A
  • All branches off the sciatic nerve
  • Piriformis receives its own nerve- “nerve to piriformis”
  • Obturator internus & superior gemellus are both innervated by the “nerve to obturator internus”
  • Quadratus femoris & gemellus inferior are both innervated by the “nerve to quadratus femoris”
56
Q

Posterior Thigh
Muscles

A

The Hamstrings

  1. Semitendinosus
  2. Semimembranosus
  3. Biceps Femoris
57
Q

posterior hamstring muscles innervated by

A

Innervated by (L5 & S1, S2) of the sciatic nerve

58
Q

____ muscle is most commonly injured of the hamstring muscles

A

biceps femoris

59
Q

hamstring muscles essentially arise from the ____ and insert distal to the knee joint

A

ischial tuberosity

60
Q

The hamstrings are vascularized by the ___ that arise from the deep (profundus) femoral artery

A

perforating arteries

61
Q

hamstring action

A

Hence…they are flexors of the knee joint and extensors of the hip joint (thigh)

62
Q

Sciatic nerve Actually contains two nerves within a common sheath:

A

nTibial nerve

nCommon fibular (peroneal) nerve

63
Q

Posterior Hip Dislocations (PHD)

A

Note the characteristic shortened, adducted, flexed, and internally rotated position of the affected extremity

PHD often result from motor vehicle accidents when the femur is flexed and adducted (sitting)

These injuries can fracture the posterior aspect of the acetabulum and cause sciatic nerve injury (~10%)

These high impact injuries are considered a medical emergency- often resulting in avascular necrosis (AVN) due to torn/damaged femoral neck vessels

64
Q
A
65
Q

______ innervates the gluteus medius, minimus, and tensor fascia lata muscles after exiting the greater sciatic foramen

A

The superior gluteal nerve (L4, L5 & S1)

66
Q

nDamage to the superior gluteal nerve can result in a ____

A

Trendelenburg gait

67
Q

nGluteus maximus is innervated by the ____ and this muscles functions when “getting up from a chair”

A

inferior gluteal nerve (L5, S1 & S2)

68
Q

_____ can traumatize the sciatic nerve and have a high incidence of avascular necrosis (AVN)

A

nPosterior hip dislocations

69
Q

_____ of the hip helps prevent hyperextension of the joint

A

nIliofemoral ligament

70
Q

____…major vascular contributor to the femoral head

A

nMedial circumflex artery

71
Q

____ cross the hip and knee joints… hence they extend the hip and flex the knee joint (cross two major joints)

A

Hamstrings muscles

MSK II (5 decks)

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